Folic Acid: Everything You Need to Know

What is folic acid? Folic acid is a water-soluble vitamin, a synthetic form of folate, which is one of the B vitamins. As your body cannot produce folate on its own, it must be obtained from your diet. Folate naturally occurs in certain foods, while folic acid is added to others and is available in dietary supplements.

Distinguishing Between Folate and Folic Acid: Although the terms "folate" and "folic acid" are often used interchangeably, they represent distinct forms of the same vitamin, namely vitamin B9. Folic acid has a different structure compared to folate and exerts slightly different effects in the body. "Folate" serves as the generic name encompassing all forms of vitamin B9, which includes folic acid and 5-MTHF, with folic acid being a specific synthetic form of this vitamin.

Sources of Folate: Folate can be found in various plant and animal-based foods, such as:

  • Spinach
  • Kale
  • Broccoli
  • Avocado
  • Citrus fruits
  • Eggs
  • Beef liver

On the other hand, folic acid is added to products like flour, ready-to-eat breakfast cereals, and bread, and is also available in dietary supplements.

Functions of Folate in the Body: Folate is essential for several crucial functions in the body, including:

  • DNA synthesis and repair
  • Facilitating proper cell growth, division, and functioning
  • Production of specific proteins
  • Maturation of red blood cells

Folate deficiency can result in various health issues, including anemia, an increased risk of heart disease and specific cancers, and developmental abnormalities in infants if expectant mothers don't receive sufficient folate. Many countries, including the United States, mandate the fortification of certain grain products with folic acid to prevent neural tube defects in infants.

Recommended Intake Levels: The Recommended Dietary Allowance (RDA) for folate is expressed in Dietary Folate Equivalents (DFEs) to account for differences in folate absorption from various sources. Natural folate is absorbed at about half the rate of folic acid from supplements.

For adults, the daily recommended intake is around 400 mcg DFE of folate. During pregnancy and breastfeeding, folate requirements may increase, with an RDA of 600 mcg DFE during pregnancy.

Folate requirements vary for different age groups, ranging from 65 mcg DFE for infants up to 400 mcg DFE for adolescents.

Benefits and Uses of Folic Acid Supplements: Folic acid supplements are used for various purposes, including:

  1. Treating folate deficiency, which can result from dietary insufficiency, certain medical conditions, and medications.
  2. Preventing birth defects and pregnancy complications, particularly neural tube defects.
  3. Supporting brain health, reducing the risk of mental impairment, dementia, and improving cognitive function.
  4. Treating mental health conditions like depression, schizophrenia, and bipolar disorder.
  5. Reducing heart disease risk factors by helping lower homocysteine levels in the blood.
  6. Addressing other health conditions, such as diabetes, fertility issues, inflammation, and kidney disease. It's important to consult a healthcare professional before starting folic acid supplements, especially if you have underlying health conditions or take other medications, to ensure there are no adverse interactions.

Folic Acid for Pregnancy: Folic acid is particularly crucial during pregnancy as it plays a vital role in fetal development, preventing neural tube irregularities like spina bifida and anencephaly. Supplementation is recommended before and during pregnancy to reduce these risks. Folic acid can also help prevent complications during pregnancy, such as preeclampsia.

Gene Variants and Folate Levels: Some individuals may have genetic variations that affect how their bodies utilize folate. Mutations in the MTHFR gene, particularly the C677T variant, can impact folate metabolism and have implications for health, including heart disease risk and neural tube defects during pregnancy.

Side Effects and Precautions: While folate-rich foods and natural folate sources are generally safe, high doses of folic acid through supplements could potentially lead to the accumulation of unmetabolized folic acid in the blood. Although there are no confirmed health risks associated with this, further research is needed.

Taking excessive folic acid during pregnancy may be linked to the development of autism in children, but more research is required to confirm this finding.

Folic Acid Interactions: Folic acid supplements may interact with certain medications, including methotrexate, epilepsy drugs, and sulfasalazine. If you're taking any of these medications, consult your healthcare professional before using folic acid supplements.

Use in Specific Groups: Folate supplements are especially important for pregnant individuals, those with conditions affecting folate absorption, those with gene variants influencing folate metabolism, older adults, individuals at risk of folate deficiency due to their diet, and those with alcohol use disorder.

It's advisable not to give folate supplements to infants under one year old, as their dietary folate needs are typically met through breastmilk, formula, and food.

Alternatives to Folic Acid: Other forms of folate, such as folinic acid and 5-methyltetrahydrofolate (5-MTHF), are available and may be considered as alternatives to folic acid. Folinic acid is a natural form of folate found in foods and is used to mitigate the side effects of methotrexate treatment. 5-MTHF is believed to absorb better than other synthetic forms of folate and may have fewer medication interactions.